| NPI | 1487065413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: PA MT205848) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA 077624) |
| 207P00000X Emergency Medicine (Licence: VA 0101262466) | |
| 207P00000X Emergency Medicine (Licence: NC 2017-00861) | |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2017-07-24 |